DESOBSTRUCTION ARTERIELLE PERIPHERIQUE PAR CATHETER DE KENSEY

: Between June 6 1988 and September 30 1989, 46 superficial femoral obliterations in 44 patients were treated by rotary atherectomy, completed by conventional dilatation in 40 patients. The 44 patients (27 males and 17 females), mean age over 66.5 years (45 to 90), presented symptomatic superficial femoral obliterations (17 tight stage, two occlusions, 5 stage III, and 10 stage IV occlusions), with mean length of 9.8 cm (2 to 24 cm). Vascular echography was performed systematically before the procedure, to assess the extent of intraluminal calcification. Moreover, a control venous angiography was performed on the third day. Of the 46 treated arteries, the occlusions which had remained impermeable with a traditional guidewire were traversed successfully and without incident in 40 cases (87%). In case 20, the massively calcified obliteration could not be traversed, and perforation occurred in four cases, but without clinical consequences. In five other cases (11%), precocious reocclusion occurred before the 48th hour. It should be pointed out that, in 2 of these 5 cases, no additional conventional dilatation had been performed at the beginning of the trial. In 35 cases (76%), satisfactory permeability with residual stenosis less than 30% was thus obtained upon discharge from the hospital. For these patients, the lower limb/upper limb Doppler index rose from 0.44 to a mean 0.89 after treatment. 2 embolism were observed: one popliteal treated by embolectomy. The mid term permeability at 6 months is 80% among the 25 primary successes.